The associations of sedentary time and breaks in sedentary time with 24-hour glycaemic control in type 2 diabetes

The aim of this study was to investigate the associations of accelerometer-assessed sedentary time and breaks in sedentary time with 24-h events and duration of hypoglycaemia (7.8 mmol/l) and above target glucose (>9 mmol/l). Thirty-seven participants with type 2 diabetes (age, 62.8 ± 10.5 years; body mass index, 29.6 ± 6.8 kg/m2) in Glasgow, United Kingdom were enrolled between February 2016 and February 2017. Participants wore an activity monitor (activPAL3) recording the time and pattern of sedentary behaviour and a continuous glucose monitoring (CGM, Abbott FreeStyle Libre) for up to 14 days. Linear regression analyses were used to investigate the associations. Participants spent 3.7%, 64.7%, 32.1% and 19.2% of recording h/day in hypoglycaemia, euglycaemia, hyperglycaemia and above target, respectively. There was a negative association between sedentary time and time in euglycaemia (β = -0.44, 95% CI -0.86; -0.03, p = 0.04). There was a trend towards a positive association between sedentary time and time in hyperglycaemia (β = 0.36, 95% CI -0.05; 0.78, p = 0.08). Breaks in sedentary time was associated with higher time in euglycaemia (β = 0.38, 95% CI 0.00; 0.75, p = 0.04). To conclude, in individuals with type 2 diabetes, more time spent in unbroken and continuous sedentary behaviour was associated with poorer glucose control. Conversely, interrupting sedentary time with frequent breaks appears to improve glycaemic control. Therefore, this should be considered as a simple adjunct therapy to improve clinical outcomes in type 2 diabetes

Nets, Spray or Both? The Effectiveness of Insecticide-Treated Nets and Indoor Residual Spraying in Reducing Malaria Morbidity and Child Mortality in sub-Saharan Africa.

Malaria control programmes currently face the challenge of maintaining, as well as accelerating, the progress made against malaria with fewer resources and uncertain funding. There is a critical need to determine what combination of malaria interventions confers the greatest protection against malaria morbidity and child mortality under routine conditions. This study assesses intervention effectiveness experienced by children under the age of five exposed to both insecticide-treated nets (ITNs) and indoor residual spraying (IRS), as compared to each intervention alone, based on nationally representative survey data collected from 17 countries in sub-Saharan Africa. Living in households with both ITNs and IRS was associated with a significant risk reduction against parasitaemia in medium and high transmission areas, 53% (95% CI 37% to 67%) and 31% (95% CI 11% to 47%) respectively. For medium transmission areas, an additional 36% (95% CI 7% to 53%) protection was garnered by having both interventions compared with exposure to only ITNs or only IRS. Having both ITNs and IRS was not significantly more protective against parasitaemia than either intervention alone in low and high malaria transmission areas. In rural and urban areas, exposure to both interventions provided significant protection against parasitaemia, 57% (95% CI 48% to 65%) and 39% (95% CI 10% to 61%) respectively; however, this effect was not significantly greater than having a singular intervention. Statistically, risk for all-cause child mortality was not significantly reduced by having both ITNs and IRS, and no additional protectiveness was detected for having dual intervention coverage over a singular intervention. These findings suggest that greater reductions in malaria morbidity and health gains for children may be achieved with ITNs and IRS combined beyond the protection offered by IRS or ITNs alone

IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT) : cluster randomised controlled trial study protocol

Background: Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidencebased clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim: This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design: This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).The trial is funded by the NHMRC by way of a Primary Health Care Project Grant (334060). JF has 50% of her time funded by the Chief Scientist Office3/2006). of the Scottish Government Health Directorate and 50% by the University of Aberdeen. PK is supported by a NHMRC Health Professional Fellowship (384366) and RB by a NHMRC Practitioner Fellowship (334010). JG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. All other authors are funded by their own institutions

Demonstration of CO2 conversion to synthetic transport fuel at flue gas concentrations

A mixture of 1-and 2-butanol was produced using a stepwise synthesis starting with a methyl halide. The process included a carbon dioxide utilization step to produce an acetate salt which was then converted to the butanol isomers by Claisen condensation of the esterified acetate followed by hydrogenation of the resulting ethyl acetoacetate. Importantly, the CO 2 utilization step uses dry, dilute carbon dioxide (12% CO 2 in nitrogen) similar to those found in post-combustion flue gases. The work has shown that the Grignard reagent has a slow rate of reaction with oxygen in comparison to carbon dioxide, meaning that the costly purification step usually associated with carbon capture technologies can be omitted using this direct capture-conversion technique. Butanol isomers are useful as direct drop-in replacement fuels for gasoline due to their high octane number, higher energy density, hydrophobicity, and low corrosivity in existing petrol engines. An energy analysis shows the process to be exothermic from methanol to butanol; however, energy is required to regenerate the active magnesium metal from the halide by-product. The methodology is important as it allows electrical energy, which is difficult to store using batteries over long periods of time, to be stored as a liquid fuel that fits entirely with the current liquid fuels infrastructure. This means that renewable, weather-dependent energy can be stored across seasons, for example, production in summer with consumption in winter. It also helps to avoid new fossil carbon entering the supply chain through the utilization of carbon dioxide that would otherwise be emitted. As methanol has also been shown to be commercially produced from CO 2 , this adds to the prospect of the general decarbonization of the transport fuels sector. Furthermore, as the conversion of CO 2 to butanol requires significantly less hydrogen than CO 2 to octanes, there is a potentially reduced burden on the so-called hydrogen economy

Estimating high risk cannabis and opiate use in Ankara, Istanbul and Izmir

Aims. Information on high risk drug use in Turkey particularly at the regional level is lacking. The present analysis aims at estimating high risk cannabis (HRCU) and high risk opiate use (HROU) in the cities of Ankara, Istanbul and Izmir. Design and Methods. Capture-recapture (CRC) and multiplier methods (MM) were applied based on treatment and police data stratified by age and gender in the years 2009 and 2010. Case definitions refer to ICD-10 cannabis (F.12) and opiate (F.11) disorder diagnoses from out- and inpatient treatment records and illegal possession of these drugs as recorded by the police. Results. HRCU was estimated at 28,500 (8.5 per 1,000; 95%-CI: 7.3-10.3) and 33,400 (11.9 per 1,000; 95%-CI: 10.7-13.5) in Ankara and Izmir, respectively. Using multipliers based on CRC estimates for Izmir, HRCU in Istanbul was estimated up to 166,000 (18.0 per 1,000; range: 2.8-18.0). CRC estimates of HROU resulted in 4,800 (1.4 per 1,000; 95% CI: 0.9-1.9) in Ankara and multipliers based on these gave estimates up to 20,000 (2.2 per 1,000; range: 0.9-1-7) in Istanbul. HROU in Izmir was not estimated due to the low absolute numbers of opiate users. Discussion and Conclusions. While HRCU prevalence in both Ankara and Izmir was considerably lower in comparison to an estimate for Berlin, the rate for Istanbul was only slightly lower. Compared to the majority of European cities HROU in these three Turkish cities may be considered rather low

Maternal alcohol intake prior to and during pregnancy and risk of adverse birth outcomes: evidence from a British cohort

Background: Evidence is conflicting regarding the relationship between low maternal alcohol consumption and birth outcomes. This paper aimed to investigate the association between alcohol intake before and during pregnancy with birth weight and gestational age and to examine the effect of timing of exposure. Methods: A prospective cohort in Leeds, UK, of 1303 pregnant women aged 18–45 years. Questionnaires assessed alcohol consumption before pregnancy and for the three trimesters separately. Categories of alcohol consumption were divided into ≤2 units/week and >2 units/week with a non-drinking category as referent. This was related to size at birth and preterm delivery, adjusting for confounders including salivary cotinine as a biomarker of smoking status. Results: Nearly two-thirds of women before pregnancy and over half in the first trimester reported alcohol intakes above the Department of Health (UK) guidelines of ≤2 units/week. Associations with birth outcomes were strongest for intakes >2 units/week before pregnancy and in trimesters 1 and 2 compared to non-drinkers. Even women adhering to the guidelines in the first trimester were at significantly higher risk of having babies with lower birth weight, lower birth centile and preterm birth compared to non-drinkers, after adjusting for confounders (p<0.05). Conclusions: We found the first trimester to be the period most sensitive to the effect of alcohol on the developing fetus. Women adhering to guidelines in this period were still at increased risk of adverse birth outcomes. Our findings suggest that women should be advised to abstain from alcohol when planning to conceive and throughout pregnanc

Discovery of Therapeutic Approaches for Polyglutamine Diseases: A Summary of Recent Efforts

Polyglutamine (PolyQ) diseases are a group of neurodegenerative disorders caused by the expansion of cytosine-adenine-guanine (CAG) trinucleotide repeats in the coding region of specific genes. This leads to the production of pathogenic proteins containing critically expanded tracts of glutamines. Although polyQ diseases are individually rare, the fact that these nine diseases are irreversibly progressive over 10 to 30 years, severely impairing and ultimately fatal, usually implicating the full-time patient support by a caregiver for long time periods, makes their economic and social impact quite significant. This has led several researchers worldwide to investigate the pathogenic mechanism(s) and therapeutic strategies for polyQ diseases. Although research in the field has grown notably in the last decades, we are still far from having an effective treatment to offer patients, and the decision of which compounds should be translated to the clinics may be very challenging. In this review, we provide a comprehensive and critical overview of the most recent drug discovery efforts in the field of polyQ diseases, including the most relevant findings emerging from two different types of approaches-hypothesis-based candidate molecule testing and hypothesis-free unbiased drug screenings. We hereby summarize and reflect on the preclinical studies as well as all the clinical trials performed to date, aiming to provide a useful framework for increasingly successful future drug discovery and development efforts.Project ON.2 SR&TD Integrated Program (NORTE-07-0124-FEDER-000021), co-funded by North Portugal Regional Operational Program (ON.2-O Novo Norte), under the National Strategic Reference Framework, through the European Regional Development Fund (ERDF) and also supported by Fundação para a Ciência e Tecnologia through the project POCI-01-0145-FEDER-016818 (PTDC/NEU-NMC/3648/2014)info:eu-repo/semantics/publishedVersio

Clinical course and prognostic factors across different musculoskeletal pain sites: A secondary analysis of individual patient data from randomised clinical trials

Background Previous research has identified similar prognostic factors in patients with musculoskeletal (MSK) conditions regardless of pain presentation, generating opportunities for management based on prognosis rather than specific pain presentation. Methods Data from seven RCTs (2483 participants) evaluating a range of primary care interventions for different MSK pain conditions were used to investigate the course of symptoms and explore similarities and differences in predictors of outcome. The value of pain site for predicting changes in pain and function was investigated and compared with that of age, gender, social class, pain duration, widespread pain and level of anxiety/depression. Results Over the initial three months of follow‐up, changes in mean pain intensity reflected an improvement, with little change occurring after this period. Participants with knee pain due to osteoarthritis (OA) showed poorer long‐term outcome (mean difference in pain reduction at 12 months −1.85, 95% CI −2.12 to −1.57, compared to low back pain). Increasing age, manual work, longer pain duration, widespread pain and increasing anxiety/depression scores were significantly associated with poorer outcome regardless of pain site. Testing of interactions showed some variation between pain sites, particularly for knee OA, where age, manual work and pain duration were most strongly associated with outcome. Conclusions Despite some differences in prognostic factors for trial participants with knee OA who were older and had more chronic conditions, similarity of outcome predictors across regional MSK pain sites provides evidence to support targeting of treatment based on prognostic factors rather than site of pain. Significance Individual patient data analysis of trials across different regional musculoskeletal pain sites was used to evaluate course and prognostic factors associated with pain and disability. Overall, similarity of outcome predictors across these different pain sites supports targeting of treatment based on prognostic factors rather than pain site alone

Definitions, Foundations and Associations of Physical Literacy: A Systematic Review

Background: The concept of physical literacy has stimulated increased research attention in recent years—being deployed in physical education, sport participation, and the promotion of physical activity. Independent research groups currently operationalize the construct differently. Objective The purpose of this systematic review was to conduct a systematic review of the physical literacy construct,as reflected in contemporary research literature. Methods: Five databases were searched using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for systematic reviews. Inclusion criteria were English language, peer reviewed, published by March 2016, and seeking to conceptualize physical literacy. Articles that met these criteria were analysed in relation to three core areas: properties/attributes, philosophicalfoundations and theoretical associations with other constructs. A total of 50 published articles met the inclusion criteria and were analysed qualitatively using inductive thematic analysis.Results: The thematic analysis addressed the three core areas. Under definitions, core attributes that define physical literacy were identified, as well as areas of conflict between different approaches currently being adopted. One relatively clear philosophical approach was prominent in approximately half of the papers, based on a monist/holistic ontology and phenomenological epistemology. Finally, theanalysis identified a number of theoretical associations, including health, physical activity and academic performance.Conclusions: Current literature contains different representations of the physical literacy construct. The costs and benefits of adopting an exclusive approach versus pluralism are considered. Recommendations for both researchers and practitioners focus on identifying and clearly articulating the definitions, philosophical assumptions and expected outcomes prior to evaluating the effectiveness of this emerging concept